Community Health Needs Assessment Question Title * 1. When you think about the place you live, what are you most concerned about? Affordable housing affordable healthcare livable wage economic opportunities clean environment affordable and healthy food choices transportation crime/vandalism drug and alcohol abuse Other (please specify) Question Title * 2. When you imagine a strong, vibrant, healthy community, what are the most important features you think of? Please choose three. good schools safe environment health care services livable wages affordable housing economic opportunities walkable and bike friendly communities parks and recreation Other (please specify) Question Title * 3. Healthcare- in your community, how much need is there for (choose top three priorities)... access to primary care providers access to dental care affordable health care short term community support after hospitalization affordable dental care access to specialty care access to alternative health care providers (acupuncture,chiropractic,etc) Question Title * 4. Mental health- in your community, how much need is there for (choose top three priorities) more mental health providers timely access to treatment early detection of mental health issues for children/teens prevention of mental health issues access to mental health services for children/teens access to residential treatment Other (please specify) Question Title * 5. Substance Use- In your community, how much need is there for…(choose three) Substance use prevention programs access to outpatient treatment access to inpatient treatment strict controls on opiates and narcotic prescriptions reduction in binge drinking reduction in marijuana use increase access to medication assisted treatment Other (please specify) Question Title * 6. Seniors- in your community, how much need is there for (choose top three priorities) Social support organizations/agencies elder care elder housing transportation affordable in home care access to long term health care access to nursing home care Other (please specify) Question Title * 7. Children and families- in your community, how much need is there for (choose top three) afterschool programming mentoring programs parenting education support for families more childcare options, good schools home visit programs for babies/new parents parent/child resource centers Other (please specify) Question Title * 8. Hunger and nutrition- in your community, how much need is there for (choose top three) access to affordable healthy foods knowledge of how to prepare health food obesity prevention programs, adequate nutrition for children adequate nutrition for seniors, more access to health foods in schools Other (please specify) Question Title * 9. Housing- in your community, how much need is there for (top three) affordable housing high quality housing housing for those with criminal backgrounds housing for those with poor credit sober housing housing for individuals with mental illness safe neighborhoods Question Title * 10. What keeps people in your community from getting medical care? (check all that apply) lack of insurance copay/deductibles are too high services are too far away don't have transportation to get to medical appointments lack of providers limited access to primary care providers limited access to specialty care language barriers no barriers Other (please specify) Question Title * 11. What is needed to improve the health of your family and neighbors? (check all that apply) healthier food job opportunities mental health services substance use treatment services transportation specialty care safe places to play/walk I don't know Other (please specify) Question Title * 12. What is your gender? male female Other (please specify) Question Title * 13. What is your zip code? Question Title * 14. How old are you? Under 18 18-29 30-39 40-49 50-59 60-69 70-79 80 or older Question Title * 15. Ethnicity Hispanic or Latino or Spanish Origin Not Hispanic or Latino or Spanish Origin Question Title * 16. Race American Indian or Alaskan Native Asian Black or African American Native Hawaiian or Other Pacific Islander White Question Title * 17. What is your highest level of education? K-8 grade Some high school High School grad Technical school Some college College graduate Graduate school Doctorate Other (please specify) Question Title * 18. Do you have health insurance? No insurance Yes- employer provided Yes- Medicaid/ Apple Health Yes- Medicare Yes- purchase private insurance on own Yes- purchase private insurance through the health exchange Done